Fancy a bite? – Medicinal leeches

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by Jemma

One of the most well-known animals in medicine is the leech, Hirudo medicinalis. Found over almost the whole of Europe and part of Asia, the leech has been collected from muddy freshwater pools and ditches for hundreds of years.

Fully mature leeches can reach up to 20 cm in length and are hermaphrodites that reproduce sexually. Leeches have suckers on each end, called the anterior and posterior suckers. The posterior (back) one is mainly used for leverage whilst the anterior (front) sucker has the jaw and teeth for feeding. Large adults can consume 5-15 ml in a single meal, which is about 10 times their body weight. After feeding, they can live up to a year before requiring another feed.

Anterior sucker of a leech attached and drawing blood. Image taken from http://en.wikipedia.org/wiki/Leech_collector
Anterior sucker of a leech attached and drawing blood.
Image taken from http://en.wikipedia.org/wiki/Leech_collector

After biting but before sucking out blood, Hirudo medicinalis secrete saliva containing about 60 different proteins. These include anticoagulants (such as hirudin), platelet aggregation inhibitors (to prevent clotting), anaesthetics and vasodilators (to widen blood vessels and increase blood flow).

Bloodletting was used by many ancient peoples, including the Egyptians and Greeks, and is one of the earliest known medical techniques. The first described use of leeches was in 800 BC by the ancient Indian surgeon Sushruta, who recommended their use for skin diseases and muscle pains.

Ancient Greek physicians Nicander, Hippocrates and Galen all advocated the use of bloodletting. Bloodletting was modelled on menstruation as they believed it purged women of bad humours (excess bodily fluid). The humours were blood, phlegm, black bile and yellow bile, and each represented air, water, earth and fire respectively. Those agreeing with this theory believed that any sickness that caused the patient’s skin to become red, such as fever and inflammation, must have been caused by too much blood in the body. Thus, removal of blood was supposed to balance the humours, allowing the body to function properly.

The four humours. Image taken from http://en.wikipedia.org/wiki/Humorism
The four humours.
Image taken from http://en.wikipedia.org/wiki/Humorism

The popularity of bloodletting rose through the centuries until it reached its peak in the early 19th century. In the 1830s, the French imported as many as 40 million leeches a year for medicinal purposes. By this time, bloodletting was used to treat almost every disease, from asthma to cholera, gangrene to epilepsy, smallpox to tuberculosis and beyond. Some of the ailments leeches were employed caused more harm than good. For example, after America’s first president George Washington developed a throat infection in 1799, he was bled for 10 hours and lost 3.75 litres of blood before dying of a throat infection.

Materia Medica jar containing two dessicated leeches
Materia Medica jar containing two dessicated leeches

The use of leeches fell drastically towards the end of the 19th century as knowledge of the bodies systems increased. However, they made a medical comeback in the 1970s. Leeches began to be used to stimulate circulation following skin grafts, particularly in finger reattachment. The therapeutic value of Hirudo medicinalis was no longer in bloodletting, but rather in the anticoagulants and anaesthetics in the saliva. Leeches are still used today but ‘mechanical leeches’ have been developed that perform the same function, though they are not yet commercially available.

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